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Information sharing, widespread collaboration on education, outcome vigilance can help curb the opioid crisis

Marcia Conrad-Miller of CGI said if payers, providers, pharma work together on oversight and create data store, progress could be made.

Beth Jones Sanborn, Managing Editor

Between 1999 and 2016 more than 400,000 lives were lost to opioid overdoses, with another 47K lost in 2017. Roughly 40 percent of those involved a prescription opioid, said Marcia Conrad-Miller, vice-president of consulting services for CGI and Brad Schoffstall, VP of consulting for CGI's health and compliance practice.

It's a crisis years in the making, that has had a devastating impact on this country. But Conrad-Miller and Schoffstall told their audience at the HIMSS19 Global Conference in Orlando that information sharing and collaboration could be key tools in curbing the crisis.

From the commercial perspective, Conrad-Miller said CGI worked with their payer partners helped them thoroughly analyze their populations with a goal of reducing the use of opioids in their customers by 25 percent.

In charting a course to this goal, CGI and their payers expanded an existing program that uses predictive analytics and the payers looked at who their patients were, who had been prescribed these drugs and who could potentially suffer an overdose.

They used CGI's connect platform as a model and worked with their own internal payer platform. They went to their provider networks and got their records, used claims data they already had, data from home pharmacies that they were paying for prescriptions from and information from physician prescriber networks. They took that massive pile and created an opioid data store with all the information around what was happening with opioids for their members/patients. Then they poured on the analytics.

They measured where the prescription concentrations were, the prescribing patterns, took stock of their physicians and our prescribers, and looked at what patients might be at risk.

"We really want to make the members healthier and manage outcomes for them," Conrad-Miller said. "Let's go out and educate our physicians and our prescribers and educate our members. Things like patterns, looking for patterns, understanding pain killers, how long you should take them."

They incorporated pharmacy alerts, so when pharmacies are dispensing particular prescriptions the system alerts that back to the physician and claims processing, and makes sure they are looking for patterns.

Clinical workflow prompts were also implemented for patient patterns, like multiple incidents where they were prescribed large dosages and having multiple visits.

Outcomes-based contracts between payers and pharma companies are one way pharma is being held accountable for their role. There, a payer will contract with pharma company and in inherent in that is a promise of certain outcomes from the use of that drug.

More and more, Conrad-Miller said, pharma companies are being legally accountable for manufacturing and delivering opioids to the marketplace using what she called "questionable marketing tactics" and other measures to get those drugs into the marketplace in large quantities.

She said payers need to educate prescribers, physicians and patients to make sure the expected outcomes from these drugs are actually happening. Research on non addictive painkillers is crucial too.

"Government needs to come together with private organizations, the prescribers, the providers the payers and the consumers. We need to educate the patients and the consumers to say you're in the middle of this and you need to be an advocate for your own health. As the regulations come about and people have access to all of their health records I think there will be a much better chance for that," she said.

Twitter: @BethJSanborn Email the writer: beth.sanborn@himssmedia.com

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